Primary and Secondary Stereotypies in Children: A Pilot Standardized Protocol and Video Analysis

Objectives: There is still a great interest in repetitive and stereotyped behaviours (RSB) and self-injurious behaviours (SIB) in children, either in typically developing children because of their evolution in time and children’s developmental profile, either in neurodevelopmental disorders, since they cause functional impairment in daily life. Our study aims to further characterize these behaviours using a standardized protocol and videotaped play-session.

Background: Twenty children with primary stereotypies (PS; n = 20) and 63 children with secondary stereotypies (SS) diagnosed with autism spectrum disorder, (ASD; n = 22) developmental delay/intellectual disability (DD/ID; n = 21), and blindness (VI; n = 20), aged from 2 to 12 years old, were assessed. Characteristics of RSB (family history, age of onset, frequency, duration, complexity, triggers, and clinical features) were collected by medical history.

Methods: Repetitive behavior scale-revised (RBS-R) and child behavior checklist (CBCL) were completed by the children’s caregivers. Frequency, duration, and types of stereotypies were coded from 20 minutes of a videotaped standardized play-session. Mean age at evaluation was 53.0 months for ASD (DS: 14.7; range, 30–96), 78.9 months for VI (DS: 31.2; range, 24–132), 70.8 months for DD (DS: 32.4; range, 24–144), 74.2 months for PS (DS: 28.3; range, 24–144). Family history of stereotypies was identified in 30% of PS sample. Mean age of onset was before 24 months in 100% of our sample. Symptoms usually occurred more than once a day, but SIB and RBS were reported at higher scores on the RBS-R in secondary group. Stereotypies lasted less than 5 minutes in ASD, DD, and PS groups, and from 5 minutes to 1 hour in the VI sample. PS group showed more complex motor stereotypies than secondary groups which presented more motor and phonic ones. Excitement was identified as a trigger in more than 80% in every group. Flapping and complex upper limbs movements were the most frequent repetitive behaviours in PS, otherwise self-directed movements (gaze hands, covering ears) were common features in secondary stereotypies. Children with ASD had the highest frequencies of gait stereotypies, while self-injurious behaviours were frequent in VI and DD groups.

Conclusion: Few studies have compared primary and secondary stereotypies including a visual impairment group. Despite similarities, differences in RSB and SIB are evident in primary and secondary stereotypies. PS show more complex movements, but the secondary group have more motor and phonic stereotypies. Self-directed stereotypies tend to be common feature of SS, while SIB seem to be related to low IQ and/or sensory impairment.